CIP Notice and Request Form Thank you for opening your investment account with us. In addition to the other forms and information required in order to establish your account, recent changes in the law require that we provide all our new accounts with this notice concerning our compliance with certain anti-money laundering requirements applicable to all financial firms, according to our firm’s Customer Identification Program (“CIP”), established pursuant to applicable provisions of the USA PATRIOT Act of 2001.This is to inform you that, pursuant to recent applicable statutory and/or regulatory requirement or guidance, supplemental customer identification information will be gathered to provide further assurance that customers opening accounts with or through National Securities Corp. have provided accurate and complete customer identification information. This is in an effort to preclude individuals or entities representing terrorist groups, drug cartels, criminal organizations, or their associates, or others known to have engaged in money-laundering activities in the past, from using this firm, or any of its associated persons, as an unwitting conduit for financing their activities. We appreciate your cooperation in helping us fulfill the goals of the USA PATRIOT Act. IN THIS REGARD, PLEASE RETURN TO US COPIES OF AT LEAST ONE ITEM LISTED BELOW AND/OR ALL SUPPLEMENTAL INFORMATION REQUESTED FOR OUR FILES (IN ADDITION TO THE NEW ACCOUNT FORM AND ANY OTHER FORMS): _____ Driver’s License_____ Passport _____ Birth Certificate _____ Photo ID _____ Background Documents _____ Personal References _____ Other _________________________________________________________ _____ Articles of Incorporation_____ Partnership Agreement_____ Trust Certificate_____ Entity Documentation_____ Governmental License/Permit_____ Business References IF YOU HAVE ANY QUESTIONS REGARDING THE FOREGOING, CONTACT YOUR REGISTERED REPRESENTATIVE. Name Email Address Phone Question Thank you! Oops!